Association Between High Blood Pressure–Specific Health Literacy and Health-Related Quality of Life Among Patients With Hypertension in Urban-Rural Fringe Communities in China

BACKGROUND: Despite rapid urbanization, no researchers have focused on patients with hypertension in urban-rural fringe areas, where rural characteristics are retained but the influences of urbanization are typically found. OBJECTIVE: In this study, we aimed to reduce health inequities by examining the status quo of health-related quality of life (HRQOL), high blood pressure-specific health literacy (HBP-HL), and social support and self-management and to explore how HBP-HL influences HRQOL among patients with hypertension in urban-rural fringe communities. METHODS: Four hundred six patients with hypertension completed physical examinations and HBP-HL, HRQOL, self-management, and social support assessments via in-person interviews. Bootstrap multiple mediating effect analysis was used to explore associations between HBP-HL and HRQOL. RESULTS: Only 24.2% of participants had a high HRQOL. None of the participants had adequate HBP-HL, only 23.2% had limited HBP-HL, and 76.8% had moderate HBP-HL. The HBP-HL score was directly correlated with HRQOL (β = 0.802; 95% confidence interval, 0.344-1.259) and indirectly correlated with HRQOL via social support (β = 0.368; 95% confidence interval, 0.202-0.568) and self-management (β = 0.314; 95% confidence interval, 0.102-0.560). The total contribution rate of the mediating effect was 41.4%. CONCLUSIONS: The HRQOL and HBP-HL scores of patients with hypertension were intermediate and inadequate, respectively. In addition, HBP-HL directly and indirectly influenced HRQOL through social support and self-management. Health providers should screen for inadequate HBP-HL in patients with hypertension before intervention. Health-promoting interventions involving HBP-HL as a breakthrough point should be tailored to control blood pressure and improve HRQOL.